Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Knee. 2020 Oct;27(5):1411-1417. doi: 10.1016/j.knee.2020.07.074. Epub 2020 Aug 19.
Unnecessary costs and complications can be reduced by minimizing blood loss and allogeneic blood transfusion in cases of total knee arthroplasty (TKA). This study evaluated the effectiveness of bone wax in reducing blood loss and transfusion rates after TKA.
A total of 674 consecutive TKAs performed for degenerative osteoarthritis were retrospectively reviewed. Propensity score-matching and inverse probability of treatment weighting analyses were performed for demographics, comorbidities, use of medications, preoperative laboratory findings and radiologic prosthetic coverage of osteotomy surface. In the bone wax group, bone wax (2.5 g) was applied to the uncovered bone section around the prostheses along with the topical administration of tranexamic acid, whereas hemostasis was achieved in the control group with the topical administration of tranexamic acid. Intergroup comparisons of estimated blood loss, decreases in hemoglobin (Hb) levels, and transfusion rates were performed.
The mean estimated blood loss and volume of postoperative drainage were reduced in the bone wax group. The maximum decreases in Hb levels on postoperative days 1, 3, 5, and 7 were 1.8 ± 0.7 ml, 2.5 ± 0.8 ml, 2.7 ± 0.8 ml, and 2.8 ± 0.8 ml in the bone wax group and 2.1 ± 1.0 ml, 3.0 ± 1.2 ml, 3.1 ± 1.1 ml, and 3.2 ± 1.1 ml in the control group, respectively. The postoperative transfusion rates decreased markedly from 8.8% to 2.0% when bone wax was used.
The use of bone wax significantly reduced blood loss, decreased Hb levels, and the risk of transfusion.
Level III, Therapeutic studies.
全膝关节置换术（TKA）中，减少失血和异体输血可以降低不必要的费用和并发症。本研究评估了骨蜡在减少 TKA 后失血和输血率方面的效果。
回顾性分析了 674 例退行性骨关节炎行 TKA 的连续病例。采用倾向评分匹配和逆概率处理加权分析比较了患者的人口统计学资料、合并症、药物使用、术前实验室检查和截骨面假体覆盖的放射学表现。骨蜡组在假体周围未覆盖的骨段上应用 2.5g 骨蜡，并局部使用氨甲环酸，对照组仅局部使用氨甲环酸止血。比较了两组间的估计失血量、血红蛋白（Hb）水平下降和输血率。
骨蜡组的估计失血量和术后引流体积减少。术后第 1、3、5 和 7 天 Hb 水平最大下降值分别为骨蜡组 1.8±0.7ml、2.5±0.8ml、2.7±0.8ml 和 2.8±0.8ml，对照组为 2.1±1.0ml、3.0±1.2ml、3.1±1.1ml 和 3.2±1.1ml。当使用骨蜡时，术后输血率从 8.8%显著降至 2.0%。
使用骨蜡可显著减少失血、降低 Hb 水平和输血风险。
III 级，治疗研究。
